Posted by linkadge on April 20, 2008, at 9:04:23
In reply to Re: OOOOOOOOOOOOooooooooo » linkadge, posted by Larry Hoover on April 19, 2008, at 16:44:39
>Well, the question of good science is one not >clearly ascribed to him, but Kirsch found that >antidepressants were more effective than >placebo, p <.001. Kirsch himself established >efficacy.
I'm sorry, I don't have time to review the data right now. I don't exactly agree with the conclusions you are reaching, but I can't say more until I review certain data myself. From what I understand this study reveals more when disected.
>Same goes for those who claim they didn't work. >Unfortunately, the plural of anecdote is not >data. That's why I rely on the science.
Statistical significance can mean different things in different contexts.
>The same dataset has been studied and analyzed >ad nauseum.
Thats why the conscensus is that antidepressants are only marginally better than placebo.
>No, I'm saying this Kirsch paper really sucks. >It is meaningless, but for its propaganda value. >NICE did a far better job of it, and before he >published.
NICE already suggests that for mild/moderate depression the benifit/risk ratio for antidepressants is poor.
>Antidepressants superior to placebo, p <.001.
From what I understand, in most trials analyzed, the difference between drug and placebo was not enough to exceed an arbitrary threshold established by NICE.
>And has always failed when put to critical >thinking tests. Only people like Kirsch, who can >ignore his own antidepressants significantly >better than placebo result, one chance in 1000
>(or less) that it is not a "real difference", >support the equivalence theory.You really think Kirsh was the first one to suggest that the difference between AD's and placebos is small. Kirsh's applicaton of a 'clinical significance' threshold is not arbitrary. Didn't he borrow it from NICE?
>Nobody ever argued that drugs work for all >depressives, but the clear evidence is that they >robustly work for some of them.And placebos work for others.
>And, as the combination of e.g. psychotherapy >and antidepressant works better than either one >aloneThat is certainly not a repeated finding. It is, however, logical. If you were in a study that gave half the patients two placebos (two supposed AD's) and the other have one placebo. Who do you think would fair better? Its all relative.
>that convincingly shows (IMHO) that there is >more to antidepressant response than simply >obtaining placebo response
Placebo + CBT also works better than placebo alone.
>....otherwise, therapy plus antidepressant would >be the same as therapy alone.
Well logically therapy plus placebo should be the same as therapy alone, but it isn't.
>Plural of anecdote not data, again.
But I am not claiming its data. When you make a case statement that is what is meant to be.
>Further experimentation is indeed the answer. >Including different drugs, also, IMHO. No point >limiting treatment opportunities based on >thought experiments.
>Assuming that serotonin levels are the issue. >You argued alternative mechanisms, earlier. ;-)>Whatever works, works.I'm not here to tell people not to take what they believe helps them.
>Dismissing them outright is dangerous, IMHO. >Look at what happened to child suicide rates as >a result of the warnings. Better management is >the answer, not drug avoidance.
Thats a separate issue. Don't get me started. Its called relative deprivation. SSRI's have no proven antisuicide effect. Take a look at say, overall US data on child suicide rates from 1950-2003 what do you see?
Linkadge
poster:linkadge
thread:823248
URL: http://www.dr-bob.org/babble/20080420/msgs/824394.html